Difficulties and Opportunities NAGC Griefinar December 3, 2010

© Bo’s Place 2010

Measuring Grief:

Introductions

Corrine Walijarvi, MS, MBA, LMSW Clinical Researcher, Bo’s Place PhD student, University of Houston,

Graduate College of Social Work Doctoral Associate, University of

Houston

Ann H. Weiss, MAT, MEd, LPC Program Director, Bo’s Place

Bo’s Place Research Goals

Promote quality researchMaintain the highest ethical

standardsProvide results useful to

practitionersProvide insights helpful to the

bereavedCommunicate research and

findings Online: NAGSS Conferences

NAGSS

Available at bosplace.0rg Summaries of peer-reviewed articles

Bibliographical information Summary of key findings Summary of service provider

implications Target audience: service providers On-going program

Why is grief research difficult?

Ethical concernsLack of consensus on definitions

What is grief? What is recovery? Resilience? Growth?

Lack of appropriate measurementsTiming issuesControl and comparison groups

Ethical Concerns

Grief research can be an effective intervention Participants in grief research identify

substantial benefits from participation: (Beck & Konnert, 2007)

Tell the story Gain insights into own thoughts, feelings Find meaning in the death (Kaufman & Kaufman,

2006) Participation contributes to greater

understanding of the grief process Normalizes the grief experience

Implications for Research

Research with the bereaved can be ethically designed and conducted

Cautions and considerations (Williams, Woodbury, Bailey, & Burgio, 2008) Time since death Choice of site Informed consent Empathic, trained interviewers Control over pace

Why is grief difficult to define?

Multiple definitions Work Processes Emotions Stages/tasks/phases

Grief is an abstract construct Nearly universal experience Uniquely experienced

Diverse models applied to grief

Psychodynamic: search for pathology

Existential: search for meaning

Cognitive behavioral: search for functioning

Systems: search for relationships

Constructionist: create on-going story

Grief Patterns

Percentages of the Bereaved

PathologyNormalGrowthReliefOther

Source: Bonanno, & Wortman, 2002

What about time frames?

At what point is intense grief pathological?

At what point should interventions be offered?

How long should interventions last? How long should follow-ups occur? Does grief end?

Much debate remains regarding timeframes

Grief as pathology

Consensus has grown after years of debate: 15% -20% of grief is pathological

Grief is a distinct construct Not depression Not PTSD

Evolution in conceptualization of pathological grief Traumatic grief Complicated grief Prolonged grief disorder

How has grief been measured?

Pathology Measurements Depression measurements Anxiety measurements Stress measurements Posttraumatic stress measurements General health measurements

Other Measurements Continuing bonds measurements Growth measurements

Criteria Proposed Traumatic Grief (2002)

Traumatic Grief More than 2 months Interferes with functioning Distressing preoccupation is present Other elements:▪ Avoidance▪ Purposelessness▪ Difficulty acknowledging the death▪ Shattered worldview

Criteria ProposedProlonged Grief Disorder (2009)

PGD-13 (Prigerson, Horowitz, Jacobs, et al., 2009) More than 6 months Significant impairment in functioning Daily experience of yearning Daily experience of intense feelings of

pain, grief, sorrow At least 5 of 9 additional cognitive,

emotional, and behavioral elements

PGD, Continued

Additional elements (5 of 9): Avoid reminders Feel stunned, shocked, dazed Feel confused (part of self has died?) Hard to trust others Trouble accepting the loss Feel bitter Moving on is difficult Emotionally numb Life is empty, meaningless

Why do the measurements matter?

Impact on the bereaved Who is diagnosed Who receives treatment/services

Impact on services What services/interventions are offered When services/interventions are offered How services are evaluated

Progress has been achieved

Studies have validated concept of PGD Unique construct (Dillen & Fontaine, 2009)

Distinct from depression, PTSD, anxiety Studies have begun to evaluate

interventions Supportive psychotherapy (Currier, Neimeyer, &

Berman, 2008)

Cognitive behavioral therapy (Boelen, de Keijser, van den Hout, & van den Bout, 2007)

Support groups (Cacciatore, 2007)

Issues Remain

PGD as a diagnostic category Will it be overused? What interventions will be developed?

Bereaved who are not diagnosed with PGD Will services continue to be offered? What measurements are needed? What interventions are needed?

Research Opportunities

Identifying/defining non-pathological forms of grief

Developing measurement instruments for progress/growth following bereavement

Identifying elements that contribute to progress/growth

Identifying interventions that contribute to progress/growth

Opportunities: Progress in Grief

Elements contributing to progress in grief Support network (Cacciatore, 2007; Feigelman,

Gorman, Beal, & Jordan, 2008)

Cognitive and affective processing (Boelen, de Keijser, van den Hout, & van den Bout, 2007; Doughty, 2009; Fleming & Robinson, 2001; Matthews & Marwit, 2004)

Meaning making (Neimeyer, Baldwin, & Gilles, 2006)

Information and knowledge (Charles-Edwards, 2009; Kinder & Cooper, 2009; Walter, 2009)

Questions?